不同儿科评定营养不良筛查工具评分的住院患儿血清前白蛋白检测及意义

Prealbumin measurement in hospitaliz ed children with different score of Screening Tool for the Assess- ment of Malnutrition in Pediatrics and its value

目的：观察住院患儿血清前白蛋白变化，探讨其在住院患儿儿科评定营养不良筛查工具评分中的价值。方法选取2013年3月至2014年4月福建医科大学附属第一医院儿科住院治疗的867例患儿为研究对象，所有患儿均于入院24 h内完成儿科评定营养不良筛查工具评分，根据评分结果分成低评分营养不良组及高评分营养不良组，同期抽取静脉血进行血清前白蛋白检测和问卷调查患儿性别、年龄、患病前后主要饮食类型等，并从临床病历中摘取患儿临床资料及实验室检查结果。结果高评分营养不良组463例（53.4％）、低评分营养不良组404例（46.6％）；高评分营养不良组、低评分营养不良组患儿血清前白蛋白浓度分别为（144.7±50.6） mg／L和（173.6±71.3） mg／L，两组比较差异有统计学意义（ t＝6.795， P＝0.000）；协方差分析在控制患儿年龄、入院前病程、白细胞数、血白蛋白、谷草转氨酶、 C反应蛋白协变量后，两组住院患儿血清前白蛋白边缘估计均值及其95％CI分别为139.8（134.9～144.8） mg／L和157.9（151.9～163.8） mg／L，高评分营养不良组患儿血清前白蛋白含量仍然显著低于低评分营养不良组（ F＝20.433， P＝0.000）。高评分营养不良并低血清前白蛋白、单纯高评分营养不良、单纯低血清前白蛋白及低评分营养不良且血清前白蛋白正常患儿临床治愈率分别为62.9％（95／151）、80.5％（251／312）、77.1％（27／35）及98.1％（362／369）（χ2＝112.80， P＝0.000），医院内获得性感染发生率分别为21.9％（33／151）、8.7％（27／312）、22.9％（8／35）及1.9％（7／369）（χ2＝63.55， P＝0.000）。结论对住院患儿进行营养不良评定筛查的同时进行血清前白蛋白检测，能更客观反映住院患儿是否存在高营养不良。

Objective To investigate the difference of serum prealbumin in hospitalized children and its value in Screening Tool for the Assessment of Malnutrition in Pediatrics （ STAMP） in hospital-izedchildren.Methods 867hospitalizedchildrenwererecruitedfromMarch2013toApril2014in the First Affiliated Hospital of Fujian Medical University .All the patients were assessed using STAMP and collected venous blood sample for measuring serum prealbumin within 24 hours after admission.All the patients were surveyed for information regarding gender , age, dietary changes, etc.and their clini-cal data and laboratory results during hospitalization collected .The patients were divided into high mal-nutrition risk group （ HMRG） and low malnutrition risk group （ LMRG） according to STAMP scores upon admission. Results There were 463 children （ 53.4%） in HMRG, and 404 in LMRG （46.6%）.Compared with the LMRG, the HMRG had significantly lower serum prealbumin [ （144.7 ± 50.6） mg/L vs.（173.6 ±71.3） mg/L, t=6.795, P=0.000].After controlling for age, course of disease, white blood cell count, albumin, glutamic-oxalacetic transaminase, C-reactive protein in covariance analysis, the HMRG still had significantly lower serum prealbumin than the LMRG [ estimate （ 95% CI）： 139.8 （ 134.9 -144.8 ） mg/L vs.157.9 （ 151.9 -163.8 ） mg/L, F =20.433 , P=0.000 ） .Clinical cure rates in HMRG with low serum prealbumin , HMRG with normal serum pre-albumin, LMRG with low serum prealbumin, and LMRG with normal serum prealbumin were 62.9%（95/151）, 80.5% （251/312）, 77.1% （27/35）, and 98.1% （362/369） （χ2 =112.80, P=0.000 ） , respectively; incidences of hospital acquired infection were 21.9% （ 33/151 ） , 8.7%（ 27/312 ） , 22.9% （ 8/35 ） , and 1.9% （ 7/369 ） （χ2 =63.55 , P =0.000 ） , respectively. Conclusion High malnutrtion could be distinguished more accurately using the combination of the as-sessment of malnutrition screening tools and serum prealbumin measurement .